Medical Marriage Q&A: Contempt and Burnout

Medical Marriage Q&A: Contempt and Burnout
By Kim Blackham
contempt, burnout, medical marriage

(Editor’s Note: In this week’s post, Marriage and Family Therapist and medical spouse Kim Blackham responds to a reader’s question from her September post on medical marriage.)

I am in tears tonight as I type this. After 10+ years of marriage I am so discouraged. I have been with my husband since undergrad. I have been with him through everything in medical school, residency, and now our first year in a “real job” He just continues to be more and more bitter all of the time and I don’t know why. I take care of 99 percent of all our house and family needs and I have never complained about his work hours. I feel like medicine has changed him through the years into a miserable person. He seems to hate life and everyone in it, including me. Please let me know if you have any advice. We also have a two and six year old.

I am so sorry you are struggling with this. It sounds like things have been rough for a couple of years now. I can understand how you would be so discouraged. You describe the problem as getting worse and escalating over the years. Without speaking to your husband, I obviously can’t say for sure, but it sounds like he could possibly be dealing with burnout.

Understanding Burnout
We will often say, “I’m burned out,” when we are tired and need a vacation. True burnout, however, is much more significant than just needing a break. True burnout is emotional exhaustion coupled with depersonalization of others – patients, co-workers, and even family members. Individuals who experience burnout will often feel inadequate and experience a diminished sense of productivity and fulfillment at work. Burnout has been extensively studied in the medical field because physicians are among those at high risk for burnout.

There are several online Burnout Assessments you can look at to give you an idea of whether or not burnout may be the cause. Please note, none of these are tested, controlled assessments. Official assessments are generally not free and are usually administered by mental health professionals or researchers. These online tools are available to help you get a general idea of what sort of support and help to seek.

Burnout can lead to contemptuous behavior towards patients, co-workers, and family members. Contempt is poisonous to a marriage. Dr. John Gottman, a national leader in the field of couples counseling calls contempt one of the four horseman of the apocalypse – meaning once it shows up, the relationship is in trouble unless it is dealt with. Contempt is communicated through sarcasm, eye rolling, cynicism, name calling, mocking and malicious humor. All of these convey disgust, which is the message I hear you get from him.

My first suggestion is to believe that the man you married is still in there somewhere. With such limited information, I can’t pinpoint exactly what has changed for your husband or your relationship over the years. I can tell you that I have seen many couples in similar situations who have worked through this seemingly insurmountable challenge and walked away with a wonderful relationship and renewed friendship. Have hope that it is possible!

Second, take a few minutes today to sit quietly by yourself and write down the reasons you fell in love with him 10+ years ago. Don’t just think about the reasons, actually write them down. You may have to dig deep to remember. When relationships are in such distress, couples have a tendency to “rewrite their history” – meaning they actually change the way they remember the beginning of their relationship and forget all the good things. Pull out pictures or old journals if you need to. Remember who he really is – independent of the medical life stress, and recall the reasons you fell in love with him.

Third, find a marriage therapist. Because this continues to escalate and get worse with time, it is likely that it will not go away on its own. Find a therapist you are comfortable with and who can help you two navigate this rocky terrain and get you back on secure ground.

I have included some important things to consider when looking for a marriage therapist:

• Find a therapist with specialized training in marriage therapy. Many therapists say they see couples, but they have no education, training, or supervision working with couples. If you needed an operation, you would seek out a surgeon, not a family practitioner – the same principle applies here.

• Find a therapist that will see both of you together. Individual therapists can be very helpful, but the most effective way to heal distress in a relationship is for both of you to be in the room. Avoid the tendency to insist he see a therapist because it is his problem. Try and approach this as a “we” problem and see the therapist together.

• Ask the therapist to explain his or her treatment approach, how many couples they see, and their success rate. Again, if you were going in for an operation, you would most likely ask the surgeon those same questions. Make sure the therapist uses an empirically validated approach and that he or she can explain it to you. It is appropriate for you to “interview” therapists to find the one that will be the best fit for you and your spouse. (Click here for more information on How to Find a Marriage Therapist.)

Hang in there. I am so sorry you are both struggling with these challenges. I hope for happier days ahead for you.


(Writer’s note: So far, all of the questions I have received have come from women who are married to male physicians. While I try to answer many of their questions in a way that acknowledges both male and female physicians, some of my responses – like this week’s post, will be addressed to the specific individual who asked the question. I recognize that over a third of the current physicians in the United States (and all of my personal physicians) are women. Please know that this is in no way a stereotypical oversight. Rather, it is a careful attempt to honor both the specific reader who asked the question as well everyone else who may read the response.

I love to hear from you. If you ever have any specific questions or concerns – related to this column or otherwise, please don’t hesitate to email me at
medical marriage

Kim Blackham is a Licensed Marriage and Family Therapist and Certified Emotionally Focused Therapist. She has extensive training in Sex Therapy and Sexual Addiction Therapy and is a frequent contributor to both online and print media. As the wife of a surgeon, she is passionate about helping couples in medical marriages. She and her husband have four children ages 3-12 and live in Tampa, Florida. Visit her online at or contact her directly at

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